Long-term air pollution exposure and cognitive impairment risk in Chinese middle-aged and older adults

Dec 13, 2025Neurotoxicology

Long-term air pollution exposure and risk of thinking problems in middle-aged and older Chinese adults

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Abstract

A 10-μg/m³ increase in particulate matter is associated with a 7.8% higher risk of cognitive impairment.

Long-term exposure to multiple air pollutants correlates with increased risk of cognitive impairment in middle-aged and older adults.
Particulate matter (PM) and nitrogen dioxide (NO) show significant dose-response relationships with cognitive impairment risk.
No association was found between ozone exposure and cognitive impairment.
The effects of NO and PM exposure were intensified over three-year exposure windows.
Higher vulnerability to cognitive impairment was identified among individuals with lower education, rural residents, those aged 60-69 years, and uninsured individuals.
Strictly linear exposure-response relationships suggest there are no safe thresholds for these pollutants.

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This prospective cohort study quantified the longitudinal associations between long-term exposure to multiple air pollutants and cognitive impairment risk among China's middle-aged and older adults. Leveraging data from 10,584 participants in the China Health and Retirement Longitudinal Study (2011-2020), we assessed high-resolution (1-km) annual exposures to particulate matter (PM, PM, PM), nitrogen dioxide (NO), and ozone (O) using satellite-based models. Cognitive impairment was defined through education-stratified Chinese Mini-Mental State Examination thresholds. Time-varying Cox proportional hazards models revealed significant dose-response relationships: per 10-μg/m³ increase, PM(HR=1.078, 95 % CI:1.022-1.136), PM(HR=1.042, 1.015-1.070), PM(HR=1.038, 1.022-1.054), and NO(HR=1.129, 1.061-1.200) elevated cognitive impairment risk, while Oshowed no association (HR=0.878, 0.743-1.038). Three-year exposure windows intensified effects for NO(HR=1.053) and PM(HR=1.034). Multi-pollutant models demonstrated PM's exceptional robustness (e.g., PM+NOHR=1.055), whereas NOattenuated finer particulate associations. Critical vulnerability emerged among adults with education below junior high (PMHR=1.30), rural residents (PMHR=1.21), those aged 60-69 years (peak PMHR=1.28), and uninsured individuals (PMHR=1.22). Strictly linear exposure-response relationships (all Pnonlinear>0.05) indicated no safe thresholds. These findings advocate prioritizing control of PM(particles ≤10 μm) alongside mitigation of traffic-related pollutants, while implementing targeted interventions for vulnerable educationally disadvantaged and rural populations to mitigate dementia burden. 1 2.5 10 2 3 1 2.5 10 2 3 2 1 10 10 2 2 1 10 1 1 10

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Long-term air pollution exposure and cognitive impairment risk in Chinese middle-aged and older adults

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